Atrial Antitachycardia Pacing and Managed Ventricular Pacing Reduce the Endpoint Composed by Death, Cardiovascular Hospitalizations, and Permanent Atrial Fibrillation
Arrhythmias, Cardiac Rhythm Management, Afib, Prevention/Vascular
Anthony A. Bavry, M.D., M.P.H., F.A.C.C.
American College of Cardiology Cardiosource(SIGNIFICANT),
Deepak L. Bhatt, M.D., M.P.H., F.A.C.C.
Elsevier Practice Update Cardiology(MODEST)
Bristol Myers Squibb(SIGNIFICANT),
The Medicines Company(SIGNIFICANT),
OTHER FINANCIAL BENEFIT:
Journal of Invasive Cardiology(SIGNIFICANT),
Slack Publications/Cardiology Research Foundation(SIGNIFICANT),
The goal of the trial was to evaluate atrial anti-tachycardia pacing (DDDRP) and managed ventricular pacing (MVP) among patients with bradycardia and previous atrial tachyarrhythmia.
DDDRP and MVP will reduce atrial fibrillation occurrence and minimize right ventricular detrimental effects.
Patients with bradycardia and previous atrial tachyarrhythmia who recently underwent permanent pacemaker placement were randomized to DDDR (n = 385), vs. DDDRP + MVP (n = 383), vs. MVP (n = 398).
Overall, 1,166 patients were randomized. The mean age was 74 years, and 50% were women.
The primary outcome occurred in 26.5% of the DDDR control group, 19.8% of the DDDRP + MVP group (p = 0.04 vs. control), and 21.4% of the MVP group (p = 0.12 vs. control).
DDDRP + MVP was associated with a reduction in permanent atrial fibrillation (hazard ratio = 0.39, p = 0.004).
Among patients with bradycardia and atrial tachyarrhythmia, the pacer mode DDDRP + MVP was superior at reducing composite cardiovascular outcomes compared with standard dual-chamber pacing. This was mainly due to prevention of permanent atrial fibrillation.
- Death, cardiovascular hospitalization, or permanent atrial fibrillation
- Patients with bradycardia and prior atrial tachyarrhythmia
Number of enrollees: 1,166 patients
Mean patient age: 74 years
Percentage female: 50%
Presented by Dr. Giuseppe Boriani at the American Heart Association Scientific Sessions, Dallas, TX, November 18, 2013.